Vol 95, No 2 (2019)

Granuloma annulare (GA) is a dermatosis of unknown etiology, which has distinctive clinical and histological features. In this article, we present current information about the etiology, pathogenesis, clinical picture and pathomorphological signs of GA, as well as conduct differential diagnosis of GA with diseases that have a similar clinical and histological picture.

Netakimab, the original monoclonal antibody against IL-17A, is an innovative drug for the treatment of moderate-to-severe plaque psoriasis in patients who have indications for systemic therapy or phototherapy. Netakimab was approved in Russian Federation, registration certificate number ЛП-005439 from 04.04.2019. This article outlines the first 12-week results of a phase III clinical trial in patients with psoriasis.

Materials and methods. The BCD-085-7 study (PLANETA) is a comparative, randomized, double-blind, placebo-controlled phase 3 clinical study of the efficacy and safety of netakimab in patients with moderate-to-severe plaque psoriasis. This review presents the results of the first 12 weeks. The study is ongoing at the moment, the total duration of treatment for each patient is 3 years (154 weeks). Patients were randomized in a ratio of 2:2:1 into one of three arms: group 1 received netakimab subcutaneously at a dose of 120 mg once a week for the first three weeks (induction) and then once every 2 weeks up to week 10, group 2 received netakimab subcutaneously at a dose of 120 mg once a week for the first three weeks (induction) and then once every 4 weeks up to week 10, group 3 received a placebo subcutaneously on day 1 at weeks 0, 1, 2, 4, 6, 8 10. In order to maintain a double-blind design, placebo was administered to patients in group 2 at weeks 4 and 8.

Results. Both netakimab groups showed a significant superiority over placebo (p < 0.001) and the absence of statistically significant differences between the two regimens of therapy (p > 0.05) across all endpoints. PASI 75 at week 12 was reached by 77.65 % of patients using netakimab once every 2 weeks and 83.33 % of patients using netakimab once every 4 weeks (ITT population). The rate of clear and almost clear skin (sPGA 0–1) was reached by 81.18 and 79.76 % of patients using netakimab once every 2 weeks and once every 4 weeks, respectively. The safety assessment showed no statistically significant differences between the groups, the incidence rate of adverse events in netakimab arms was not higher than in the placebo arm. There were no cases of early withdrawal due to adverse events and cases of grade 4 toxicity according to CTCAE 4.03. During the 12 weeks of the study, one serious adverse event was registered in group 2 (pneumonia grade 3), which was recovered without any consequences. The immunogenicity assessment showed binding antibodies formation at week 12 in one patient who received BCD-085 every 2 weeks. Neutralizing antibodies were not detected. Conclusion. Netakimab showed high efficacy in the treatment of psoriasis, more than 80 % of patients achieved PASI 75 and sPGA 0–1 (clear and almost clear skin) by the week 12 of treatment. The drug showed a favorable safety profile and low immunogenicity. Based on the study results the regimen once a week during the first 3 weeks (induction), then once every 4 weeks was chosen for medical use in patients with psoriasis.

Primary cutaneous T-cell lymphomas encompass a heterogeneous group of T-cell lymphoproliferative disorders developing primarily in the skin and characterized by a number of specific diagnostic, clinical, and therapeutic features. Mycosis fungoides accounts for more than half of all cutaneous lymphoma cases, while CD30+ lymphoproliferative diseases of the skin (primary cutaneous anaplastic large-cell lymphoma and lymphomatoid papulosis) constitute one-fourth of them and the remaining cases are rare tumour types, including primary cutaneous peripheral T-cell lymphoma, unspecified/not otherwise specified.

Activation antigen СD30 is a cell membrane glycoprotein of the tumour necrosis factor family. More than 75 % of primary cutaneous CD30-positive lymphoma cells express CD30; it may be detected in other diseases as well, but to a lesser extent.

Most patients with cutaneous CD30+ lymphoproliferative diseases have indolent disease and a favourable prognosis; resistant disease is observed in approximately 30 % of sufferers, and fatal outcomes occur in 8 % of cases [1].

Systemic immunomodulatory therapy or chemotherapy is often used in advanced disease. Monoclonal antibodies were recently introduced into clinical practice for the treatment of cutaneous lymphomas. One of these agents is brentuximab vedotin, a CD30-monoclonal antibody conjugated to monomethyl auristatin E.

We present two case reports: one of frequently recurring lymphomatoid papulosis and the other of refractory primary cutaneous peripheral T-cell lymphoma, unspecified/not otherwise specified. Targeted therapy with brentuximab vedotin, either alone or in combination with chemotherapy, resulted in a sustained, long-lasting remission in both cases.

Aim. To present a clinical case of pemphigus vegetans, a rare form of dermatosis.

Materials and methods. A clinical and laboratory examination of a 32-year-old woman complaining of rash was carried out. The rash in the form of blisters, pustules, erosions and vegetating lesions was located mainly on the mucous membranes and skin folds. The list of performed examinations included a cytological study of a swab taken from the bottom of a lesion, a histological examination of skin biopsies from a lesion and an immunofluorescence study of biopsy specimens taken from an apparently non-affected skin area.

Results. The clinical manifestations of the disease and the results of the conducted histological examinations corresponded to the diagnosis of pemphigus vegetans. The diagnosis was confirmed by the presence of acantholytic cells in the swab and IgG deposits in the intercellular spaces of the epidermis. Oral therapy with prednisone at a dose of 1 mg/kg body weight per day led to regression of the rash.

Conclusion. In the investigated clinical case, the localization and nature of skin lesions were typical of pemphigus vegetans. The conducted histological and enzyme immunoassays confirmed the diagnosis, which allowed an adequate therapy to be selected. As a result, the patient demonstrated a pronounced clinical improvement. The described case is presented due to the rarity of this dermatosis.

Two clinical cases of a complicated course of the primary period of syphilis are present. Attention deserves the severity of the clinical picture of a solid chancre, which could cause certain diagnostic difficulties.

Treatment of psoriasis and psoriatic arthritis, especially moderate and severe, represents difficulties. Recently, various methods of molecular medicine have been actively developed, however, targeted therapy deserves special attention, which consists of chemical agents that have specific target as a specific protein or enzyme. Targeted therapy is a promising direction in many branches of medicine, especially in dermatology.

Despite the wide range of biological products, their use may be accompanied by an increased risk of infectious processes and malignant neoplasms, which makes the search for a new pharmacological solution in targeted therapy even more relevant.

This review presents the possibilities and prospects for the therapeutic use of the phosphodiesterase-4 inhibitor from the group of small molecules — apremilast, primarily in the treatment of psoriasis and psoriatic arthritis.

Background. According to European and RF clinical guidelines, only the systemic use of isotretinoin in severe acne has a high level of evidence. However, this therapy is frequently associated with the development of retinoid dermatitis, the prevention and correction of which requires the application of emollients. Aim. To evaluate the efficacy and tolerability of the Perfectoin cream during treatment and prevention of retinoid dermatitis in patients with severe acne receiving systemic treatment with isotretinoin.

Materials and methods. Two groups of patients each comprising 38 people with moderate, severe and resistant to standard therapy forms of acne were observed. Each group included 22 patients with retinoic dermatitis manifestations and 16 without such symptoms. The patients in the main and comparison groups were prescribed the Perfectoin cream and the dexpanthenol cream, respectively. Control of the skin condition was performed prior to the study and following 1, 3 and 6 months of therapy. Assessment parameters were the main symptoms of retinoid dermatitis (erythema, lichenification, excoriation, itching, feeling of dryness/tightness of the skin), indicators of the hydration of the horny layer of the epidermis and the transepidermal loss of moisture, as well as the dermatology life quality index.

Results. The study has shown that the Perfectoin cream in patients with acne receiving isotretinoin therapy helps to restore skin hydration and leads to a rapid regression of the main dermatological symptoms of retinoid dermatitis, thus improving the overall quality of patients’ life.